THE ROLE OF ROMIPLOSTIM IN CHEMOTHERAPY-INDUCED THROMBOCYTOPENIA TREATMENT.
(Abstract release date: 05/19/16)
EHA Library. Entrena Ureña L. 06/09/16; 132974; E1425
Mrs. Laura Entrena Ureña
Contributions
Contributions
Abstract
Abstract: E1425
Type: Eposter Presentation
Background
The thrombocytopenia due to chemotherapy and/or marrow infiltration is a common complication in cancer patients. When it is moderate or severe, it can cause difficulties in the clinical management and the continuity of full-dose treatment. Romiplostim stimulates the thrombopoietin receptor inducing proliferation and differentiation of megakaryiocites, so administered at the right time, it could lead to a faster recovery or maintenance of platelet counts, avoiding delays and dose adjustments which may cause poor response to chemotherapy.
Aims
To evaluate safety and efficacy from Romiplostim in post-chemotherapy thrombocytopenia.
Methods
15 patients with malignancies, 11 non-hematologic (2 breast cancer, 2 colon cancer, 2 carcinoid tumors, 1 glioblastoma multiforme, 1 neuroendocrine tumor, 1 endometrial cancer, 1 germ cell tumor and 1 small cell lung cancer) and 4 lymphomas (2 follicular lymphomas, 1 diffuse large B-cell lymphoma and 1 Hodgkin lymphoma) were treated with Romiplostim. The median age was 54 years (29-84) and the median baseline platelet counts was 69 x 109 L (8-90). All were receiving chemotherapy, 3 in first-line and the rest in second-line or later and 53% had marrow invasion. 14 patients develop cytopenia, requiring red cells transfusion (60%), platelet transfusion (47%) and the use of granulocyte-colony stimulating factor (G-CSF) (66%). The median starting dose of Romiplostim was 1 mcg/kg (1-3) and the median maintenance dose was 3 mcg/kg (1-4), for a median time of 50 days (7-322).
Results
2 patients achieved no response, one of them requiring continued platelet transfusion support to carry on with chemotherapy. 87% of patients achieved response, in 11 cases with platelet counts of > 100 x 109L. This allowed the use of full-dose chemotherapy and according to the initial scheme, except for dose adjustment in 2 cases due to platelet counts of < 50 x 109L. Romiplostim treatment was well tolerated, with no treatment-related toxicities observed. No haemorrhagic events were reported over this period.
Conclusion
Thrombopoietin and its receptor are new therapeutic targets in the development of drugs for diseases associated with thrombocytopenia. Apart from his habitual use, Romiplostim achieved an increase in platelet counts in cancer patients, even after several treatment lines, making possible the use of full-dose chemotherapy and without delays, which could result in a therapeutic benefit. Despite the good results achieved, it would be necessary a larger number of patients to prove the thrombopoietin receptors agonists as equivalents to G-CSF and erythropoietin in post-chemotherapy cytopenias.
Session topic: E-poster
Keyword(s): Thrombocythemia
Type: Eposter Presentation
Background
The thrombocytopenia due to chemotherapy and/or marrow infiltration is a common complication in cancer patients. When it is moderate or severe, it can cause difficulties in the clinical management and the continuity of full-dose treatment. Romiplostim stimulates the thrombopoietin receptor inducing proliferation and differentiation of megakaryiocites, so administered at the right time, it could lead to a faster recovery or maintenance of platelet counts, avoiding delays and dose adjustments which may cause poor response to chemotherapy.
Aims
To evaluate safety and efficacy from Romiplostim in post-chemotherapy thrombocytopenia.
Methods
15 patients with malignancies, 11 non-hematologic (2 breast cancer, 2 colon cancer, 2 carcinoid tumors, 1 glioblastoma multiforme, 1 neuroendocrine tumor, 1 endometrial cancer, 1 germ cell tumor and 1 small cell lung cancer) and 4 lymphomas (2 follicular lymphomas, 1 diffuse large B-cell lymphoma and 1 Hodgkin lymphoma) were treated with Romiplostim. The median age was 54 years (29-84) and the median baseline platelet counts was 69 x 109 L (8-90). All were receiving chemotherapy, 3 in first-line and the rest in second-line or later and 53% had marrow invasion. 14 patients develop cytopenia, requiring red cells transfusion (60%), platelet transfusion (47%) and the use of granulocyte-colony stimulating factor (G-CSF) (66%). The median starting dose of Romiplostim was 1 mcg/kg (1-3) and the median maintenance dose was 3 mcg/kg (1-4), for a median time of 50 days (7-322).
Results
2 patients achieved no response, one of them requiring continued platelet transfusion support to carry on with chemotherapy. 87% of patients achieved response, in 11 cases with platelet counts of > 100 x 109L. This allowed the use of full-dose chemotherapy and according to the initial scheme, except for dose adjustment in 2 cases due to platelet counts of < 50 x 109L. Romiplostim treatment was well tolerated, with no treatment-related toxicities observed. No haemorrhagic events were reported over this period.
| P | AGE | TYPE OF NEOPLASM | STAGING | LINE TREATMENT | PLATELETS BEFORE TREATMENT | OTHER CYTOPENIAS | PLATELET TRANSFUSION | RED CELL TRANSFUSION | INITIAL DOSE OF ROMIPLOSTIM | MAINTENANCE DOSE OF ROMIPLOSTIM | RESPONSE | TREATMENT TIME (DAYS) |
| 1 | 36 | Breast | 4 | 9 | 8x10⁹L | Yes | Yes | Yes | 1 | 4 | No | 60 |
| 2 | 60 | Colon | 4 | 1 | 90x10⁹L | Yes | Yes | No | 1 | 4 | Yes (>100x10⁹L) | 231 |
| 3 | 70 | Carcinoid | 4 | 1 | 14x10⁹L | Yes | No | Yes | 3 | 3 | Yes (>100x10⁹L) | 180 |
| 4 | 54 | Glioblastoma | 4 | 2 | 70x10⁹L | Yes | Yes | Yes | 1 | 2 | Yes (>100x10⁹L) | 280 |
| 5 | 58 | Folicular lymphoma | 4 | 3 | 27x10⁹L | Yes | No | No | 2 | 2 | Yes (>100x10⁹L) | 35 |
| 6 | 41 | Germ cell tumor | 4 | 1 | 65x10⁹L | Yes | No | No | 2 | . | Yes (>100x10⁹L) | 7 |
| 7 | 52 | Endometrium | 4 | 3 | 84x10⁹L | Yes | No | No | 1 | 3 | Yes (>100x10⁹L) | 322 |
| 8 | 84 | Folicular lymphoma | 4 | 5 | 69x10⁹L | Yes | No | Yes | 1 | 3 | Yes (>100x10⁹L) | 50 |
| 9 | 61 | Small cell | 3 | 4 | 72x10⁹L | Yes | No | Yes | 1 | . | Yes (>100x10⁹L) | 7 |
| 10 | 42 | Carcinoid | 4 | 3 | 24x10⁹L | Yes | No | No | 1 | 4 | No | 50 |
| 11 | 52 | Neuroendocrine | 4 | 5 | 65x10⁹L | Yes | Yes | Yes | 1 | . | Yes (>100x10⁹L) | 7 |
| 12 | 29 | Hodgkin lymphoma | 3 | 4 | 19x10⁹L | Yes | Yes | Yes | 1,5 | . | Yes (>100x10⁹L) | 7 |
| 13 | 56 | Colon | 4 | 5 | 82x10⁹L | Yes | No | Yes | 1,5 | . | Yes (>50x10⁹L) | 7 |
| 14 | 54 | Breast | 4 | 5 | 85x10⁹L | No | Yes | No | 1 | 4 | Yes (>50x10⁹L) | 60 |
| 15 | 37 | Diffuse large B-cell lymphoma | 2 | 2 | 72x10⁹L | Yes | Yes | Yes | 1 | 1 | Yes(>100x10⁹L) | 14 |
Conclusion
Thrombopoietin and its receptor are new therapeutic targets in the development of drugs for diseases associated with thrombocytopenia. Apart from his habitual use, Romiplostim achieved an increase in platelet counts in cancer patients, even after several treatment lines, making possible the use of full-dose chemotherapy and without delays, which could result in a therapeutic benefit. Despite the good results achieved, it would be necessary a larger number of patients to prove the thrombopoietin receptors agonists as equivalents to G-CSF and erythropoietin in post-chemotherapy cytopenias.
Session topic: E-poster
Keyword(s): Thrombocythemia
Abstract: E1425
Type: Eposter Presentation
Background
The thrombocytopenia due to chemotherapy and/or marrow infiltration is a common complication in cancer patients. When it is moderate or severe, it can cause difficulties in the clinical management and the continuity of full-dose treatment. Romiplostim stimulates the thrombopoietin receptor inducing proliferation and differentiation of megakaryiocites, so administered at the right time, it could lead to a faster recovery or maintenance of platelet counts, avoiding delays and dose adjustments which may cause poor response to chemotherapy.
Aims
To evaluate safety and efficacy from Romiplostim in post-chemotherapy thrombocytopenia.
Methods
15 patients with malignancies, 11 non-hematologic (2 breast cancer, 2 colon cancer, 2 carcinoid tumors, 1 glioblastoma multiforme, 1 neuroendocrine tumor, 1 endometrial cancer, 1 germ cell tumor and 1 small cell lung cancer) and 4 lymphomas (2 follicular lymphomas, 1 diffuse large B-cell lymphoma and 1 Hodgkin lymphoma) were treated with Romiplostim. The median age was 54 years (29-84) and the median baseline platelet counts was 69 x 109 L (8-90). All were receiving chemotherapy, 3 in first-line and the rest in second-line or later and 53% had marrow invasion. 14 patients develop cytopenia, requiring red cells transfusion (60%), platelet transfusion (47%) and the use of granulocyte-colony stimulating factor (G-CSF) (66%). The median starting dose of Romiplostim was 1 mcg/kg (1-3) and the median maintenance dose was 3 mcg/kg (1-4), for a median time of 50 days (7-322).
Results
2 patients achieved no response, one of them requiring continued platelet transfusion support to carry on with chemotherapy. 87% of patients achieved response, in 11 cases with platelet counts of > 100 x 109L. This allowed the use of full-dose chemotherapy and according to the initial scheme, except for dose adjustment in 2 cases due to platelet counts of < 50 x 109L. Romiplostim treatment was well tolerated, with no treatment-related toxicities observed. No haemorrhagic events were reported over this period.
Conclusion
Thrombopoietin and its receptor are new therapeutic targets in the development of drugs for diseases associated with thrombocytopenia. Apart from his habitual use, Romiplostim achieved an increase in platelet counts in cancer patients, even after several treatment lines, making possible the use of full-dose chemotherapy and without delays, which could result in a therapeutic benefit. Despite the good results achieved, it would be necessary a larger number of patients to prove the thrombopoietin receptors agonists as equivalents to G-CSF and erythropoietin in post-chemotherapy cytopenias.
Session topic: E-poster
Keyword(s): Thrombocythemia
Type: Eposter Presentation
Background
The thrombocytopenia due to chemotherapy and/or marrow infiltration is a common complication in cancer patients. When it is moderate or severe, it can cause difficulties in the clinical management and the continuity of full-dose treatment. Romiplostim stimulates the thrombopoietin receptor inducing proliferation and differentiation of megakaryiocites, so administered at the right time, it could lead to a faster recovery or maintenance of platelet counts, avoiding delays and dose adjustments which may cause poor response to chemotherapy.
Aims
To evaluate safety and efficacy from Romiplostim in post-chemotherapy thrombocytopenia.
Methods
15 patients with malignancies, 11 non-hematologic (2 breast cancer, 2 colon cancer, 2 carcinoid tumors, 1 glioblastoma multiforme, 1 neuroendocrine tumor, 1 endometrial cancer, 1 germ cell tumor and 1 small cell lung cancer) and 4 lymphomas (2 follicular lymphomas, 1 diffuse large B-cell lymphoma and 1 Hodgkin lymphoma) were treated with Romiplostim. The median age was 54 years (29-84) and the median baseline platelet counts was 69 x 109 L (8-90). All were receiving chemotherapy, 3 in first-line and the rest in second-line or later and 53% had marrow invasion. 14 patients develop cytopenia, requiring red cells transfusion (60%), platelet transfusion (47%) and the use of granulocyte-colony stimulating factor (G-CSF) (66%). The median starting dose of Romiplostim was 1 mcg/kg (1-3) and the median maintenance dose was 3 mcg/kg (1-4), for a median time of 50 days (7-322).
Results
2 patients achieved no response, one of them requiring continued platelet transfusion support to carry on with chemotherapy. 87% of patients achieved response, in 11 cases with platelet counts of > 100 x 109L. This allowed the use of full-dose chemotherapy and according to the initial scheme, except for dose adjustment in 2 cases due to platelet counts of < 50 x 109L. Romiplostim treatment was well tolerated, with no treatment-related toxicities observed. No haemorrhagic events were reported over this period.
| P | AGE | TYPE OF NEOPLASM | STAGING | LINE TREATMENT | PLATELETS BEFORE TREATMENT | OTHER CYTOPENIAS | PLATELET TRANSFUSION | RED CELL TRANSFUSION | INITIAL DOSE OF ROMIPLOSTIM | MAINTENANCE DOSE OF ROMIPLOSTIM | RESPONSE | TREATMENT TIME (DAYS) |
| 1 | 36 | Breast | 4 | 9 | 8x10⁹L | Yes | Yes | Yes | 1 | 4 | No | 60 |
| 2 | 60 | Colon | 4 | 1 | 90x10⁹L | Yes | Yes | No | 1 | 4 | Yes (>100x10⁹L) | 231 |
| 3 | 70 | Carcinoid | 4 | 1 | 14x10⁹L | Yes | No | Yes | 3 | 3 | Yes (>100x10⁹L) | 180 |
| 4 | 54 | Glioblastoma | 4 | 2 | 70x10⁹L | Yes | Yes | Yes | 1 | 2 | Yes (>100x10⁹L) | 280 |
| 5 | 58 | Folicular lymphoma | 4 | 3 | 27x10⁹L | Yes | No | No | 2 | 2 | Yes (>100x10⁹L) | 35 |
| 6 | 41 | Germ cell tumor | 4 | 1 | 65x10⁹L | Yes | No | No | 2 | . | Yes (>100x10⁹L) | 7 |
| 7 | 52 | Endometrium | 4 | 3 | 84x10⁹L | Yes | No | No | 1 | 3 | Yes (>100x10⁹L) | 322 |
| 8 | 84 | Folicular lymphoma | 4 | 5 | 69x10⁹L | Yes | No | Yes | 1 | 3 | Yes (>100x10⁹L) | 50 |
| 9 | 61 | Small cell | 3 | 4 | 72x10⁹L | Yes | No | Yes | 1 | . | Yes (>100x10⁹L) | 7 |
| 10 | 42 | Carcinoid | 4 | 3 | 24x10⁹L | Yes | No | No | 1 | 4 | No | 50 |
| 11 | 52 | Neuroendocrine | 4 | 5 | 65x10⁹L | Yes | Yes | Yes | 1 | . | Yes (>100x10⁹L) | 7 |
| 12 | 29 | Hodgkin lymphoma | 3 | 4 | 19x10⁹L | Yes | Yes | Yes | 1,5 | . | Yes (>100x10⁹L) | 7 |
| 13 | 56 | Colon | 4 | 5 | 82x10⁹L | Yes | No | Yes | 1,5 | . | Yes (>50x10⁹L) | 7 |
| 14 | 54 | Breast | 4 | 5 | 85x10⁹L | No | Yes | No | 1 | 4 | Yes (>50x10⁹L) | 60 |
| 15 | 37 | Diffuse large B-cell lymphoma | 2 | 2 | 72x10⁹L | Yes | Yes | Yes | 1 | 1 | Yes(>100x10⁹L) | 14 |
Conclusion
Thrombopoietin and its receptor are new therapeutic targets in the development of drugs for diseases associated with thrombocytopenia. Apart from his habitual use, Romiplostim achieved an increase in platelet counts in cancer patients, even after several treatment lines, making possible the use of full-dose chemotherapy and without delays, which could result in a therapeutic benefit. Despite the good results achieved, it would be necessary a larger number of patients to prove the thrombopoietin receptors agonists as equivalents to G-CSF and erythropoietin in post-chemotherapy cytopenias.
Session topic: E-poster
Keyword(s): Thrombocythemia
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